*Purpose: Colonized microbes in lower respiratory tract (LRT) of deceased donor allograft can potentially cause early posttransplant pneumonia (EPTP) that leads to detrimental outcome in lung transplant recipients (LTRs). Little is known on whether donor multidrug-resistant organisms (MDROs) by aspiration or pre-harvest mechanical ventilation may be direct cause of EPTP or in relation to mortality.

*Methods: A total of 90 bilateral LTRs aged ≥ 18 years were reviewed at Severance Hospital between Oct. 2013 and May 2017. All of the subjects received lung transplantation (LTx) immediately after admission without pre-LTx LRT infection (LRTI). 81 in-patient LTRs who received LTx on previous hospitalization were not included, in order to avoid impact of pre-LTx LRTI on EPTP. Quantitative culture in bronchoalveolar lavage (BAL) was performed in bilateral LRT of all pre-anastomosis allografts and LTRs at post-LTx 3 days. Prophylactic antibiotics were modified by BAL cultures in allografts and LTRs. EPTP within post-LTx 30 days was defined according to the ISHLT consensus. MDRO was confined by bacteria that were resistant to at least one agent in ≥ three antimicrobial categories.

*Results: Out of all (non-MDR or MDR) 85 organisms grown in 60% (54 of 90) of allografts, 88.2% and 11.8% were bacteria (27.0% of GPC and 61.2% of GNB) and fungi. BAL culture at post-LTx 3 days revealed that out of 60 organisms grown in 50% LTRs, 71.7% and 28.3% were bacteria and fungi. 24.4% (22 of 90) of pre-anastomosis allografts and 28.9% (26 of 90) of LTRs at post-LTx 3 days were MDROs, which were most commonly A. baumannii and K. pneumoniae. Only eight (8.9%) and four (4.4%) LTRs had identical organisms and MDROs in both pre-anastomosis allograft and LRT at post-LTx 3 days. Organisms identified in 26 (28.9%) of donor disappeared in LTRs at post-LTx 3 days, but 17 (18.9%) LTRs newly acquired organisms at post-LTx 3 days. Identification of all organisms and MDROs in pre-anastomosis allograft were not associated with EPTP (P=0.707 and 0.748) and all-cause in-hospital mortality (P=0.710 and 0.934). Older age of ≥ 50 years was independent factor related to EPTP in multivariate regression model (OR, 2.86, P=0.039).

*Conclusions: High rate of preexistent MDROs in donor allografts did not result in EPTP and mortality in LTRs. This data suggests that allografts with MDROs can be safely used in LTx.

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